The secrecy of . . . miscarriage

The loss of a child is a devastating and painful experience. Coping with the grief of a miscarriage or stillbirth is complicated by gynaecological health, illness, pain, trauma, uncertainty and often silence. The feeling of “empty arms” is not something a mother can prepare for amid the anticipation of motherhood and so they can often be unprepared to navigate the powerful bereavement reactions they may experience.

The complex and pervasive symptoms of depression, anxiety, and post-traumatic stress can highlight the isolation a parent experiences in their loss which can have an additional effect on anxieties during future pregnancies.

“About one-in-five women have a miscarriage,” says Dr Sieglinde Mullers, consultant obstetrician and Gynaecologist in The Rotunda Hospital and Maternal-foetal Medicine Specialist, “so unfortunately it is one of the most common obstetric complications we encounter.

“Some women with certain medical conditions, or women with advancing maternal age may be at increased risk of miscarriage. In most cases, however, it cannot be prevented. Miscarriage can happen to any woman and in all my years of clinical practice, it never gets easier, having to break the bad news.”

Michael D Higgins: ‘What I had was a form of mild stroke. It didn’t affect my cognitive abilities’

---

Trapped and starving, two families in Gaza Strip try to keep their children alive

---

EU could be preparing tougher car emissions rules

---

Leinster provide too many players to the national squad for it to be an equitable system

---

The silence surrounding a mother’s experience of pregnancy loss can be pervasive with miscarriage and stillbirth having the same impact as it is the commitment to a pregnancy and the significance of that loss that matters, not the duration. Experiencing pregnancy loss does not mean someone should cope with their grief and experience alone. This silence is shifting amid the vulnerability of bereavement. Several prominent women have shared their stories publicly allowing others to share theirs and hold space for their grief.

Dr Mullers believes there is a lot less silence about pregnancy loss today with healthcare professionals and patients far more open to considering and discussing the emotional aspects of miscarriage and stillbirth and the impact this can have on women’s wellbeing and that of their families.

“Now more than ever we are acknowledging and openly discussing the effect losing a baby or babies has on a woman, her partner, and her extended family,” says Dr Mullers. “There is more societal awareness and openness to discussing pregnancy loss. Several public figures, for example Síle Seoige and Rosanna Davison, have so bravely shared their experiences in public and I commend them and others for doing so.”

Research has shown that “the trauma of perinatal loss was found to impact parents for up to 12 years following the loss experience”. The emotional trauma of pregnancy includes symptoms of post-traumatic stress, with sleep disturbance, dizziness, and headaches being common characteristics linked with the trauma of loss.

[ ‘I blamed myself for not wanting it enough’ – Untold tales of pregnancy loss ]

“The unanticipated loss of a baby during childbirth is a particularly traumatic event for anyone,” says Dr Mullers. “There are often many unanswered questions at the time, and it can be extremely difficult for a woman who is recovering physically from childbirth to be faced with this enormous, consuming grief. She may have other children at home to consider, or the support network may not be well established.

“It can also be challenging for staff directly involved and those caring for the family. There is often a huge paradox between the clinical, physical, and emotional needs. Our bereavement team dedicate themselves to ensuring families feel supported both in the short- and long-term and that families fully understand what is happening.”

As clinical lead for the bereavement services in the Rotunda Hospital, Dr Mullers says that the door is always open to return to the hospital’s bereavement services. “In my experience, most of our families are open to receiving immediate support from our bereavement team,” she says. “Following pregnancy loss, the immediate focus is naturally centred on the medical aspects of care, ensuring the safety of the mother through the course of her miscarriage or delivery. Clinical and emotional supports are often required simultaneously and can be challenging.”

As a mother, I understand those feelings of guilt and that immense responsibility we place on ourselves to get things ‘right’

—   Dr Sieglinde Mullers

There are times, perhaps in early pregnancy, when a loss may not be recognised by friends, family, or colleagues, leaving parents to grieve in isolation which can have a detrimental affect on their mental wellbeing. Disclosing the loss to others can be met with unintentional insensitive comments, overwhelming ambiguity, confusion, and worries about ineffective communication with partners, employers, or healthcare providers.

“It is important for us to recognise women who are particularly vulnerable,” says Dr Mullers, “for example, those with background mental health difficulties, previous poor obstetric outcome, women with recurrent pregnancy loss, those experiencing a pregnancy with a foetal abnormality, or termination of pregnancy. Pregnancy loss can be traumatic for any woman in any circumstance, and it is important for us to ask the difficult, non-clinical questions.”

The HSE National Standards for Bereavement Care are being implemented throughout maternity units in the country, providing a framework for bereavement support. The Rotunda Hospital offers a dedicated bereavement team supporting women and their partners with tools on how to navigate loss and communicate the loss to friends, family, and other children.

[ I thought I knew something about miscarriage. But I hadn’t a clue ]

“I feel we are better, now more than ever, at inquiring about women’s mental health and that of their partners, and equally women are more open to talking about their experiences of pregnancy loss,” says Dr Mullers. “I completely accept this may not be everyone’s experience, but the vast majority feel they are supported by us in the immediate aftermath and longer term.”

Processing grief often includes trying to understand the underlying cause of the loss. Unfortunately, there is often no answer. Dr Mullers is regularly asked the question, “Did I cause this?” or “Did I do something wrong?”

“This question breaks my heart each time,” she says, “because as a mother, I understand those feelings of guilt and that immense responsibility we place on ourselves to get things ‘right’. It is important as healthcare professionals to offer reassurance and reiterate that of course it is not their fault or their partner’s fault and to do our best to investigate any causes or factors that may explain what happened and can potentially be modified going forward.”

For some, silence is their preferred lived experience at that time, and they may not be ready to talk

—   Dr Sieglinde Mullers

Dr Mullers explains that, in the vast majority of cases of miscarriages, there is no identifiable cause. “Women with recurrent miscarriages are offered a review and further investigations in our specialist Recurrent Miscarriage clinic. In approximately one-half of stillbirths no cause is found, and this can be particularly difficult for parents to come to terms with. We are increasingly recognising we need to be very mindful of the language we use and the way we communicate pregnancy loss and have ongoing training for healthcare professionals to address this.”

[ ‘Words in my life: Miscarriage, IVF, bleeding, guilt, sympathy, anger, grief . . . and hope’ ]

Grief in pregnancy loss is a personal and individual experience, often silent, secret, held closely and privately. How that grief is processed and supported is also individual but deserves attention, to be discussed, heard, and talked about when the time is right for the individual.

“Every couple is unique,” says Dr Mullers, “and may experience the effects of losing a baby differently over time. For some, silence is their preferred lived experience at that time, and they may not be ready to talk.”

If you have been affected by this article, support is available from the Miscarriage Association of Ireland, Féileacáin and Samaritans

The secrecy of . . .

• Periods
• PND
• Contraception
• Miscarriage